Proton range verification using a range probe: definition of concept and initial analysis

Proton therapy can be particularly sensitive to changes or errors in range. Thus, methods for the in vivo measurement of range could be of great use to improve the quality and accuracy of proton-based radiotherapy. In this paper, we introduce the concept of the 'range probe'. This is a low-dose, high-energy proton pencil beam that would pass through a patient, and whose integral Bragg peak would be measured on the exit side using a multi-layer detector. We propose that by comparing the measured integral Bragg peak with that calculated based on the patient's planning CT, such a range probe could provide useful information about the accuracy of range calculations in vivo. To study the feasibility of this approach, a Monte Carlo-based study has been performed. Using a patient's planning CT, MC simulations (VMCpro) have been made for single pencil beams laterally traversing the head and stopping in a simulated range telescope behind the patient. Range probes have been calculated for different locations, and the residual range from the Bragg peak 'signal' in the range telescope has been assessed for different assumed detector thicknesses. The sensitivity of this approach to changes in CT values, calibration curve and positional shifts of the CT have been investigated. From our analysis, range resolutions of 1 mm may be possible with a detector thickness of 4 mm for homogeneous regions. Additionally, for heterogeneous regions, changes of the Bragg peak shape due to spatial shifts of the CT could be a sensitive measure for detecting patient set-up errors directly in the treatment position. The concept of the proton 'range probe' appears to be feasible for high-resolution range verification. We now want to test this concept experimentally using different possible range telescope detectors.